And as long as a nameless, faceless commissioner is the one who is going to be the intermediary of what you can have and can't have, then in essence the entire law is a death panel. And still, no one can tell me why there is a compelling need to go through with government run healthcare.

I was really struck, reading this article, between the Times' flat statement that the "death panel" rumor was false, and the rest of the article which made perfectly clear that substituting palliative care for treatment was a cost effective way to reduce the 1/3 of Medicare spending that goes in the last two years of life.

It is clear to everyone except our confused President that the points necessary to stay treatable by the Government health care monopoly must be decided by either (1) a lottery, or(2) by a written objective list of values assigned by the authority of a Panel of Medical Ethics Experts and administered without political favortism. I would not be surprised if many independent Americans would elect the Lottery method over the Death Panel method.

I agree. End of life decisions should remain in private hands - by which I mean the hands of private insurers.

Everyone knows that as long as no reforms are passed, health care will never be rationed and no one will ever die.

Never mind that the bill never provided for "end of life" consultation unless a patient requested it. Death panels are easier to get outraged about, and let's face it - "outrage" feels empowering.

PS - As a lawyer who has represented several large health insurers (defending med mal cases), I honestly have no idea how a thinking person can valorize the manner in which palliative care decisions are currently being made within the halls of private insurers.

PPS - I am not defending any of the multiple bills currently proposed, but let's be honest, the current system unsustainable and on occasions disgraceful.

I thought the descriptions on hospice (hospice rocks!!!!) in the article were very interesting. It's seemingly used only at the very very end in metro New York, and that's not my experience here in the Midwest at all -- our neighbor is a Hospice Nurse, with some patients there for months. Which was my experience too, earlier this year, although that was on and off.

And I disagree with flexo -- a good healthcare provider is going to provide you with all your options. That should include thinking about DNR orders.

Dr. O’Mahony - curiously, one of my cousins, a Scot, and a Cambridge grad, studied Scottish Gaelic with his professor Dad.

Perhaps one of the worst things US medicine did was create the template of "whatever the victim or victim's family wants...and our hero doctors will strive to make it happen.."Cost no object. Terminal cancer or heart failure becomes instead of 2 fairly comfortable months on the way out - into 4-5 months of agony, surgeries, futile dehabilitating chemo...with deranged or deluded patients and caregivers convinced that holding on whatever the pain and non-existent prospects of improvement. Convinced that the "brave" thing to do. To fight at any price.

My uncle died of early congestive heart failure. He withered down to a cachexic skeleton in his last 8 months. On an ostomy bag and no teeth and loss of vision in both eyes, extremity gangrene, and some brain function loss because lack of oxygen was killing parts of him from episodes when his blood pressure cratered. Little amputations as dead toes were cut off, and gangrened material on his bedsores removed. Then dementia. And heroic measures were demanded by his wife to keep him alive. At all costs, she demanded. Early on, he was given false hope..then as things progressed, his "Caregiver", our aunt, took over. He was too sick to fight her, and the doctors too reticent to fight her. And his kids had no say.

In his lucid moments, he occasionally said he wanted to die to his kids and his wife, who assured him that the doctors would save him, a heart transplant might happen if she could get the rules waived.."don't quit!!"

Insurance caps were reached early, and the last 300,000 or so was all on the taxpayer.

It was a long, horrific end, with our final visit to him a month before he went seeing him moaning in pain and goingin and out of reality and saying he smelled the rot of his death. (no amount of deoderant could mask the smell).

If we move past that and create rational rules in best interest of teminal patients - agreed to by ethicists - it WILL save money. That in itself will not be a bad thing if we end these awful futile, interventions at end of life that do not give compassion and help...but inflict misery and succor delusions.

Flexo - "And it is another thing entirely for government to suggest it or promote it, whether the idea comes from a "panel" or not."

Where in the article did you read anything relating to the "government" suggesting anything?

This is the part that I could relate to, especially considering the pain my dad and our whole family suffered through for almost 18 months, before he died of lung cancer:

"They are tour guides on the road to death, the equivalent of the ferryman in Greek myth who accompanied people across the river Styx to the underworld.

They argue that a frank acknowledgment of the inevitability of death allows patients to concentrate on improving the quality of their lives, rather than lengthening them, to put their affairs in order and to say goodbye before it is too late."

(...during training at a prominent cancer hospital in New York, he changed his mind as he saw patients return to the hospital to die miserable deaths, hooked to tubes, machines and chemotherapy bags until the end.")

The entire "death panel" nonsense is just that, and anybody who has experienced what we did knows it.

This article just continues the meme that "Death Panels" was a reference to the end-of-life counseling that was required (shall has a particularly meaning when it occurs in legislation), and not to the countless bureaucracies that HR3200 proposes, the dozens of panels that will be making decisions based on "best outcomes" or some other statistical nonsense. Those death panels are all still in the legislation and are going nowhere.

The left advocates for death panels again. Amusingly, they also express dismay that the right is talking about the left advocating for death panels... in the same article.

Obama would be so much better off if he had come out saying what he really wanted: death panels and single payer, and explained he was willing to compromise with the reforms we've got in place now.

Instead, it's Obama pretending he never said what we've all seen him saying about his grandma's hip, and pretending his staff having been joking that this is a backdoor to trick us into single payer. Now, we just don't trust him. We know Obama's a liberal now. He still could have had his bill, and earned credit for compromising with the moderates. Instead, he lied to us, so we don't trust him or the NYT.

"If we move past that and create rational rules in best interest of teminal patients - agreed to by ethicists - it WILL save money."

I do agree with C4 about saving money the: last two years of life incur the largest medical costs. And the approach he outlines will work in theory. However, I suggest that approach will never survive the political process--even IF and big if--medical ethicists agreed to it. Is the current process good? it appears it is the cost of deferring to the individual to make the decision. It isnt perfect, thats for sure.

On a side note, it was my lawyer who suggested I consider a living will at the time I filled out my will--No doctor was involved in the process.

I've mentioned this before, but when my dad was dying, he was in a Catholic hospital and the doctors, what whatever reason, were reticent about giving him any real pain meds...because they felt he would become "addicted." They also said his complaints were based on a "low pain threshold" and that it was all in his mind.

I argued that he was already addicted to death and that any relief would be appreciated.

It took many aggressive confrontations on my part, along with the hospice workers helping out, before they finally relented and provided what he needed.

I will never forget him crying as he told me that it was the first time in over 6 months that he was not in constant pain.

When he finally died it was discovered that the cancer had moved into his bones, which was the prime reason for much of what his doctors referred to as "imagined" pain.

Based on many of the comments I find it difficult to believe many here have experienced the final months, and especially the final days of a loved one's life.

You appear to concentrate of the silly notion that a doctor or anyone for that matter, counseling someone on what they may expect, and to help put things in order...is some kind of interference in the process and those who are dying should be left alone. (And the insane canard that the "government" is going to be sending in some kind of "death panel" is just that; insane,)

Some day you'll see...and hopefully it won't be too late for you or those who are destined to pass.

My heart goes out to you. I lost my mother to lung cancer in 1971, when I was 14 and they didn't have near the treatments available that they do now. It was awful, frankly.

My wife's Mother and oldest sisters both died of cancer last year and both were in home hospice. Again it was sad.

The hard part during her mother's death was that my wife's large family - she has 7 siblings and they all were there the last 7 days - didn't know how to deal with the reality of it. Some believed that the time estimate till death was way off, one believed she would be healedmiraculously, others were just wanting to comfort their mother as much as possible, others to see her out of her misery. Conversations that would normally be tense at worst became extremely heated and almost physical as everyone tried to deal with their grief during her last days. Some wounds are still open among some of the family and it will likely be a long time coming.

Here's where I'm going with this: Would professional counseling - getting all available family members together and explaining the realities of the final days, done by a professional, perhaps aided by clergy, have helped? This conservative believes so. Should that professionals fees be covered by the insurance that provides the hospice or end of life care? I believe most of us would say yes. But should such counseling be mandatory? No.

The difficulty comes when the insurance company, government or privately run, says that no, your relative is determined to be terminal with in such and such a time frame, and there will be no further treatment, please consider hospice. It has to happen eventually to a larger and larger number of people because of the numerous factors - the aging population, the sheer size and cost of the deficit among them. Even if Obama and the Democrats fail to change one bit of health care from the way it is today, the cost of health care will continue to rise and will eventually force such decisions. It is already that way in both England and Canada, it is inevitable in the United States.

So, "death panels" while a despicable label, is really a fear of what the future must hold: not putting certain people directly to death, but certainly declining to provide for many who's lives will surely be shortened with out treatment.

I must say that I do agree with C4 and others who realize that sometimes heroic measures at the end of life are just not worth it.

HOWEVER, these types of decisions are best left to the family and not in the hands of government lackeys who are looking to save the medical program a buck or in the hands of a panel that is trained to offer death.

My aunt died of lung cancer. She did have treatments that were experimental that prolonged her life by a few years, but upon realizing that that was going to be it. No cure. She opted for hospice care and died at home in a few months. It was HER choice.

My mother was in a very long coma many years ago from an auto accident. We were told at first that she was probably not going to make it. When she fooled the doctors and lived, still in the coma, we were told that she would be a vegetable and probably better off if we removed the ventilator. When she no longer needed the ventilator and still lived in a coma for many months we debated daily....what should we do? What would Mom want us to do. Should we do what the doctors were gently persuading us to do?

Surprise....she came out of the coma and with physical therapy regained much use of her abilities. She joined a bowling league. Joined art classes. My parents went to Costa Rica and Europe for vacations. She lived for another 20 years and was only 38 at the time of the accident. She lived long enough to see her grandchild come into the world.

If we had taken the advice of the doctors..none of this would have happened. Fortunately my parents had good health insurance provided by work and didn't go over the maximum pay out and she was able to get good therapy. My father would have sold the house and anything to continue to keep my mother with him if the coverage ran out. Again HIS CHOICE.

When we have the government making these decisions for us by rationing care or by having people paid to persuade you to die, instead we lose the ability to have free will and become nothing more than a statistic in some faceless bureaucrats manila folder.

People have to make these life and death decisions all the time. People, not the government, not a clerk somewhere. Family and loved ones and they should not be coerced and prodded into chosing death.

Jeremy...My point about tobacco was that once the medical system has expelled a dying man, the respect for his life should allow some "rule breaking" to recognise his special personhood. Otherwise the Khafkaesque nature of his required dying to help out the common good is hatefull.

Joan is right. The 'death panels' are still in the legislation in the form of counsels that will decide how much medical care a person is entitled to based on their age and conditions.

People who are already handicapped will not be given the same treatment for the same conditions. Older people will be weighed as to their usable/functionable life span against the cost of the treatment. Knee surgery...forget it if you are over a certain age.

In addition there will be rationing across the board. Only so many dollars devoted to any certain proceedure and if the money runs out early in the year....tough luck. Think that won't happen? Take a look at the Native American Government run healthcare plans. Look at England. Look at Canada.

I am sorry for the loss of your aunt and very happy about your mother.

But again, rationing at the end of life care will become increasingly necessary in the future whether or not Obama and the Democrats change Health Care one iota.

I am glad that your aunt had the provision for experimental treatment. And I too want decisions to be made in the family. But that opportunity for experimental care - and even known care for prolonging life by times as short as a year - will be less available in the future to all using any kind of insurance. Only those with direct resources will be able to have the full range of options.

What this means is that 10 years from now, if your aunt was ill, it is more likely that she would be denied the experimental treatment through insurance. The cost curve is trending that way, and there is no economist anywhere that denies it.

Knowing this now allows us all to =begin making life decisions about our health, health care, and life values.

While I do think counseling w/r/t end of life decisions, especially when facing catastrophic illness, ought to be voluntary, I also tend to think it's underutilized (especially on the family, not just patient, level). As noted by another commenter here, emotions (the whole range of them) can run VERY high in such situations, and this certainly can run counter to the best interests of the profoundly ill person.

I think the very term "rationing" is a misnomer, because I don't think medical attention has to be rationed in any way.

If hospice and honest counseling was readily available during my dad's illness, he would have left the hospital at least 6 or more months before his death (which occurred at home within a few days of his coming home). His care would have been literally the same, and he would have been with us every day of the week, every hour of the day.

When I reviewed the hospital, doctor and medication bills after he died I realized the total for the last 6 months of his hospital stay totaled up to over $400,000.

I was told by the hospice people that had he been moved home, put on full pain medications and cared for by an in-home nurse, the care would have been just as good or even better, and the total would have been at least 50% less.

I think if more people understood what the term "terminal" really means, and the kinds of money and profits associated with the last months of their lives...they would opt for the comfort and peace of being at home, with their loved ones versus the hospital.

Again: this is MY PERSONAL opinion, based on my own experiences with my dad and others.

DBQ - HOWEVER, these types of decisions are best left to the family and not in the hands of government lackeys who are looking to save the medical program a buck or in the hands of a panel that is trained to offer death.

The problem is that the patient or family may have the least ability to think clearly. My Aunt was a great example of that. In the name of fighting "no matter what" she gave her husband a life from hell his last 6 months, cost taxpayers over 300,000 dollars, and absolutely wrecked her relationship with her children..3 of 4 who no longer speak to her 2 1/2 years after my uncle died.

We don't totally defer to "FAMILY!!!" in other matters. We saw how stupid that was in grovelling to the every demand and wish of the 9/11 Victims Familys and Katrina survivors that the rest of us would pay whatever was needed to satisfy them. We found we HAD to limit the endless escalation of demands from Special Ed student parents. "Soldiers Families" do not set military strategy. Or the guy with liver cancer and congestive heart failure wanting a liver transplant gets what he wants.

I see some rules and limits approved by ethicists as unavoidable. Especially considering we have the technology can keep a baby Schiavo alive nearly indefinitely at 200,000-425,000 a year from the taxpayers if "the parents want it so". The 37 trillion dollar gap between Medicare reciepts and past, present, and future expenses.

And all the end of life horror stories created in most part by ill-informed, deluded, or emotionally irrational "family".

The problem is that the patient or family may have the least ability to think clearly. My Aunt was a great example of that

This is an excellent point. The family might need some help or outside counseling. I just object to it coming from the government or the insurance companies who have a vested interest in the patient expiring before they spend more money.

Perhaps a church group, a non religious organization, charitable organization, even just some good friends who might be dispassionate and help the families make these hard decisions.

PS - As a lawyer who has represented several large health insurers (defending med mal cases), I honestly have no idea how a thinking person can valorize the manner in which palliative care decisions are currently being made within the halls of private insurers.

So you want the government instead to valorize palliative care instead? I'll take my chances with the private sector thanks.

PPS - I am not defending any of the multiple bills currently proposed, but let's be honest, the current system unsustainable and on occasions disgraceful.

And yet you get paid to defend it. I'm not sure what's worse, but if you want honesty, the system is perfectly sustainable as it is now, but with current government intrusion and regulations may give the perception of unsustainability and frankly who is it unsustainable with? There could be many good fixes to plugging up the gaping holes in the private system, but to much special interest money flows to keep those holes open. That is the modus operandi of the cabal that large private institutions have set up with large government institutions. They've become indistinguishable in their bureaucratic characterization. However, that being said, I'm still in favor of letting the private sector with the least amount of government intrusion work itself out and I'll look out for my best interests. Thank you very much.

The democrats are unable or simply refuse to see any difference between me choosing something on my own, with my own money, and a panel of unelected unaccountable bureaucrats making that choice for me.

I think everyone needs to go read Dust Bunny Queens post re, the death panels; since that is what Sarah Palin was originally talking about, i.e. allowing the government to decided how much health care a person was entitled to based on the value of the person. That is why she mentions the government denying treatment to her son.

One point- you should never underestimate the degree to which family members can make completely selfish decisions when it comes to the health care of their aged relatives.

Also- we should not underestimate the degree to which an expert can pressure a person into making a decision which is in the best interests of the expert.

That may be why the default standard should be, do whatever prolongs life.

"But again, rationing at the end of life care will become increasingly necessary in the future whether or not Obama and the Democrats change Health Care one iota"

Why? This is what I think is so frustrating to so many. Because economists say so? I reject that entirely. I reject that because I am an American, and I believe in the American people. I reject that because that is crass defeatism masked in compassionate sentimentality. I reject that because it then goes on to say because it's bad, well, we might as well hasten and control the process so that everyone gets rammed into their most convenient end.

Ann posted a very interesting article about a very interesting man and a very interesting aspect of medicine. He should be indeed honored for this particular bit of service. But, that's not at all the issue. The issue is that in saying rationing is inevitable we won't be all seeing a kind, handsome young Irishman who gently guides desperate families through the end-of-life decisions that an untreatable, terminal condition necessitates.

There's only so many young, handsome Irishman to go around, and they're not all into talking to the impending dead.

For all those who face the untreatable, last stage cancer and die, there are those who break the odds, who live way past their expected date, who battle terrible injuries and diseases, sometimes through the benefit of experimental surgery. And they live and they thrive for years after.

We do not have to give in to the naysaying that just because the system is broke, it's going to get much much worse so we might as well shackle ourselves to an unwieldy, unfunded bureacracy which when facing the kind of budget shortfalls the present Clunkers program faces will increasingly broaden the range of the impending dead from the "no hope" to the just inconvenient and expensive, leaving there no more to say, "I'm getting better!"

Real leadership, real help, would argue that the system is unwieldy, needs fixing, and then fight to bring reforms to what does work, broadening help to those who need it, while not breaking the system for whom it really does work.

Things are bad and are getting worse is a terrible--dare I say unAmerican--reason to overhaul the system towards crazily unwieldy proportions in the middle of an already history lack of funding. UnAmerican not in terms of patriotism, but in terms of innovation, hope, leadership, creativity.

I say no to the fact we all just have to lower our heads and slowly walk to our worse-off health care future. That's giving up, and that's giving up in the name of some so-called progressive stance that is more about hopelessness than ingenuity. If the Democrats can only say, "it's bad but we'll ease your pain," then I say move them out and let's get people in who say "America has risen above expectations in the past, and is not condemned to the future naysayers proclaim."

That's what Reagan did with the communist states, and I have every reason to believe that it could be the same way with health care and other aspects of our life.

We're Americans, dammit. We work our asses off so the next generation has it better. We model what can be possible, not what we're condemned to have.

I said: I can't think of anything worse than being surrounded by "concerned" strangers at the end.

Jeremy asked: Who are these "strangers" you're referring to?

His doctors, the nurses, the hospice workers?

My answer is: All of the above. I'm not trying to be flip.

A man is dying. Any man. Me. You. Just as his life is unfathomable to himself, so is his death, and mysterious, mysterious beyond all reckoning. I don't want to be poked and prodded by strangers as death draws near. No matter how concerned they are. Especially if they're concerned. I want the mystery to be honored.The fact that millions die miserably, the fact that millions die daily or weekly or what ever the statistic is is not relevant.This whole fight and the reason it is so passionate is that it is a fight to the finish between those who see life as matter, just so much junk, and those who know it is holy even if they don't know what they mean by holy.My life is holy. Get your dirty paws off me you damnable apes.

rhhardin said..."It's rationing if you can't get as much as you want, which is what happens when the immediate cost to you is less than cost of supplying it."

And once again: The insane notion that the government is going to step in and tell doctors when to stop administering aid.

*And by the way...I notice no one has mentioned or complained about how the horrible "government" stepped into and all over the "private family matters" related to the Terri Shiavo affair. Here you had all of the doctors telling anyone who would listen, that the woman was brain dead, yet the certain parties on the right spent months with their faces plastered all over the TV spouting beliefs that were 100% medically wrong.

The "rationing" argument is bullshit and nothing more than the wing nut version of what they want people to believe.

Why? This is what I think is so frustrating to so many. Because economists say so? I reject that entirely.

When there is only so much of a resource to go around and that resource is controlled by a central authority, it is certain that there will be rationing.

They won't call it that. It will be longer wait times or you will be steered into another, different and possibly lesser procedure instead. The hospitals will be reimbursed at a certain level, just like now with Medicare and Medical, will not be enough to cover their costs. Their only solution is to do less of some procedures.

Today, the slack, the shortfall in revenues with the government plans for hospitals and doctors is picked up by private payers. Either those with good insurance or those who can pay in cash. When more and more people are on the Government plan and less and less are able to afford private insurance or private insurance is finally squeezed out of the market, there will be rationing and a reduction in the quality of care.

Doctors are already in a shortage. In my rural area, we are very short on doctors and medical facilities. When the government funding replaces private funding the shortages will be even less.

I know you don't like the idea because you are a compassionate person and feel that people have good intentions. I too don't want to give up and accept our decline into a souless society where people are thought of as commodities to be measured and deemed worthy of medical care or denied the opportunity to live because their lives are not valuable. However, this is the future that the Obama's and liberal/socialists are going to foist upon us if we don't stand up and scream.....STOP!!!!

If you're ever actually in the situation of being there when someone you care about is dying and has no hope, a lot of the moral judgments many of you (and Sarah Palin) are making don't really apply. A DNR agreement isn't some sort of evil thing; it's something that's done in a difficult situation when someone is suffering and is going to die. And the people who work in hospice care and help those who really are going to die generally are wonderful people and doing something selfless and worthy with their lives. It's incredibly unfair to use the term "death panels" and essentially accuse people who work in end-of-life care as being murderers. They're doing something that's very important, and you should hope that, when you're old and dying, you'll have some pretty well-funded hospice care with some nice, warm people working there. If you believe in karma (not that I do), trashing, persecuting, and making outrageous accusations against those people is probably not a good thing.

What is the point of arguing about whether or not Obama plans to deny care to people? Who cares? Maybe he doesn't plan to.

But it is a simple, objective fact that the supply of available medical care is highly inelastic. It takes one to two decades to add a new doctor to the existing supply.

If you want to increase the amount of medical care one portion of the population is receiving, you must decrease the amount of care the remainder receives. It doesn't matter if you "plan" to. Most people who gorge themselves on junk food don't "plan" to get fat, either. The laws of nature don't care what you plan for. What's even worse is that Obama is talking about eliminating the normal means by which increased supplies are encouraged: rising prices. He's specifically talking about cutting the remuneration provided to those who supply health care. This always leads to reductions in supply, meaning even less care to spread around.

So why waste air arguing about whether or not Obama WANTS granny's care cut short by some bureaucrat? That granny's care will be cut is a given. The only question is whether or not Obama knows enough about economics to understand that simple truth.

"You appear to concentrate of the silly notion that a doctor or anyone for that matter, counseling someone on what they may expect, and to help put things in order...is some kind of interference in the process and those who are dying should be left alone. (And the insane canard that the "government" is going to be sending in some kind of "death panel" is just that; insane,)"

That was never really what was being talked about, because that is not how it is likely to go down. Rather, some unelected bureaucrat, or panel of such, is going to decide whether or not people are going to get treatments for one thing or another. If you listen to what Obama and Dr. Emanuel have said, you are led to believe that it will be similar to the British system where age, health, etc. will be weighed into the decision.

The big question is how much these decisions are set up in advance, presumably through some sort of complex equations, that the bureaucrats just have to crank through to determine whether treatment is authorized or not. In the end, most of it will likely be computerized, to eliminate as much of the variability as possible. Maybe.

The end of life counseling was just the trigger for looking into this area of ObamaCare. It was more symptomatic than anything. But that wasn't what Gov. Palin was talking about with her disabled son. And that isn't what most are talking about now when we discuss "death panels".

The real issue is the rationing of health care by the unelected bureaucrats, no matter how it is done, that is the inevitable result of ObamaCare's insistence of covering more people for more health care for less money. It just cannot be done without serious rationing, which we really haven't faced before now.

The elderly are most worried about this, for good reason. Medicare hasn't rationed up until now, and it will have to start doing so, regardless of ObamaCare. But ObamaCare appears to be trying to cover all those uninsured by hitting those on Medicare the hardest.

Frankly, I think the idea of end-of-life counseling is just fine, and don't have any problem with it being paid for by health care insurers, as long as it is strictly voluntary.

And once again: The insane notion that the government is going to step in and tell doctors when to stop administering aid.

This isn't insane, Jeremy, this is what happens in states and countries when government controls the health care purse strings.

Canada, England, and I believe the State of Oregon, use formulas to determine whether or not you will receive treatment. Bureaucrats use a formula to determine if your life is worthy enough to try to save.

I don't have a problem with hospice care. I don't have a problem with what the doctor in the Times article does, because they do what they do based upon a patient's or family's decision. It is strictly voluntary.

However, put the government in control of health care, and the government will decide if and/or when to administer treatment.

It happens every day in government-run systems, and it will happen in the U.S. if HR 3200 becomes law.

They know who is more likely to suffer silently, and when is the best time to suggest a do-not-resuscitate order.

Under Obamacare that time will be much easier to determine (Anytime!) and the discussion will go something like this:

"Well, granny, that hangnail hasn't improved much since last week, so I'm here to help you with the difficult decision you have to make next: burial or cremation. Are you aware that burial is much better for the environment than cremation? Obama will appreciate your helping to reduce our carbon footprint, and the sooner we can sequester your carbon, the better."

Paddy O. said... "But again, rationing at the end of life care will become increasingly necessary in the future whether or not Obama and the Democrats change Health Care one iota"

Why? This is what I think is so frustrating to so many. Because economists say so? I reject that entirely. I reject that because I am an American, and I believe in the American people.

DBQ gave you the basic facts of supply and demand, and a partial one about who pays for a resource that Freedom Lovers!!! and welfare mommas alike consider to be a right they don't have to pay for, or pay higher taxes for.

Partial, because in addition to private payers and insurers picking up the slack of people that consume far more medical care than they pay for as costs are spread - it is the government that sucks up most of cost, even in the present system. And government has for decades just slapped the excess cost into long-term debt and unfunded Medicare mandate.

All the money people paid in Medicare taxes is gone. Disbursed out to other, older people for the most part who didn't pay taxes enough to cover exploding healthcare costs. 37 trillion in unpaid obligations now exist.

With Bush and other cowards adding bells and whistles like prescription drugs, free AIDs care, obligatory treatment of illegals - without balancing this with any new taxes.

So, the system is on the verge of being bankrupt. The dollar is threatened with destruction. The Chinese are backing off on IOUs for our now unsustainable low-tax, high entitlement society - particularly healthcare costs.

That leads to only three endpoints, given the unsustainability:

1. Rationing of healthcare, with caps on the salaries and profits of those in the healthcare industry. To lower our costs 50-80% to what other advanced nations pay.

2. Higher taxes. To be sustainable, it would require the young to pay a 18-21% tax on medicare so granny can keep getting anything she wants and pass her estate on tax-free.

3. Some combination of the two.

The days of Right-wingers saying no taxes but give "The Family!" whatever care they or the patient demands are rapidly coming to an end.The days of Left-wingers saying its no ones business but the welfare momma when she shows up with her 4th cocaine and fetal alcohol syndrome multiple handicapped preemie demanding "The Best Care Imaginable!" are coming to an end.

Revenent - The laws of nature don't care what you plan for. What's even worse is that Obama is talking about eliminating the normal means by which increased supplies are encouraged: rising prices. He's specifically talking about cutting the remuneration provided to those who supply health care. This always leads to reductions in supply, meaning even less care to spread around.

No, it doesn't. If you look at the facts of national healthcare systems, Europe and Asia create more doctors, nurses and hospital beds available per capita than your "Freedom - for Freedom Lovers!!" US healthcare system.

@Meth - The illusion you cling to that your insurace company is responsive to "market" pressures is amusing.

Awesome deflection, but meaningless nonetheless and even more so from a lawyer for the poor. It's not an 'illusion' that I cling to. It's the ideal that given the choice between several insurance carriers that I can go to for my insurance needs vs. the only one, namely government, guess who I will go with? The one that will give me the most of what I can get or want for the least amount of money I want to pay with all the options in between.

Your notion that government ends up becoming a one-size fits all solution as a function of dealing with issues of the poor is a delusion that only a lawyer would claim. However, to my insurance company I'm a constant premium subscriber. It's in their best interests to honor their agreements when I need to make a claim otherwise our lawyers will have to sit down and have discussion. But you see, when government doesn't honor their agreements, what are my avenues for grievances then, hmmm? Oh, that's right, there is none. When government tries to be everything to everybody, it ends up treating everyone like nobody. Don't believe me? Then go ask your vaunted poor that you represent.

No, it doesn't. If you look at the facts of national healthcare systems, Europe and Asia create more doctors, nurses and hospital beds available per capita than your "Freedom - for Freedom Lovers!!" US healthcare system.

And pay 50-80% less for it.

It is how the system is designed that matters.

And yet they have egregious waiting lists for some of the most basic health care procedures, from stress tests to MRIs to joint replacement surgeries.

It is hard to believe that Obama does not understand the economics of what he is proposing.

It makes much more sense that he views his health care initiatives as another form of "spreading the wealth around"--that he will take health care from people who now have provate insurance and redistribute it to people who do not. This creates a net loss for people with resources and a net gain for people without resources. Another way of saying this is that he will take some of the health of those with private insurance and give it to those who don't have private insurance.

This is generally consistent with Obama's views on "soical justice." It is a shame that he doesn't instead try to "spread the productivity around"--something Bill Clinton tried very hard and quite successfully to do. It is also a shame that Obama does not want to deprive himself or spread his own wealth around. Thus, he bought, with Tony Rezko's help, a house with a 5,000 bottle wine cellar and seven fireplaces. And as very affluent private citizens, he and Micle gave almost no money to charity (see his tax returns) and most of what he id give went to Jeremiah Wright.

So, why are we surprised that we don't like him or his policies very much?

Cedarford said...No, it doesn't. If you look at the facts of national healthcare systems, Europe and Asia create more doctors, nurses and hospital beds available per capita than your "Freedom - for Freedom Lovers!!" US healthcare system.

And pay 50-80% less for it.

It is how the system is designed that matters.

You've just made a quantity over quality argument. First of all, asia is 1/4th the world population and it only stands to reason that they will need so many medical practitioners to service an even larger populace. They may also pay 50% to 80% less because frankly their economic setup heavily subsidizes that cost via the level of taxation they have to endure. Europe just as well. They are working on a precarious and unsustainable system. Quantity over quality. Guess which Americans will pick every time?

Meth, read more slowly. I represent insurance companies. Again, I. represent. insurance. companies. Got it? Not sure where you got your "the poor" tick from, but please, read more carefully in the future.

Ok - now, to repeat my basic point - from my perspective (represenitng several insurance carriers), not only is the insurance industry in most states not currently response to market pressures, but they actively lobby to be sure they won't be. Next, you like your insurance. Great. God forbid, you come down with a serious illness. 1) do you think you can choose any available treatment, or do you acknowledge your "private" insurance company will make decisions (WITHOUT CONSULTING WITH YOU) about what care they will cover? (i.e ration your care) 2) Supposing, hypothetically, you don't like your company's decision under your current plan, will you just enroll in another plan? With your now pre-existing condition? Ha. Good luck.

You responses indicate not only a blind faith in markets, but a depressingly poor understanding of the industry you are defending.

No, it doesn't. If you look at the facts of national healthcare systems, Europe and Asia create more doctors, nurses and hospital beds available per capita than your "Freedom - for Freedom Lovers!!" US healthcare system.

Cedarford, please get your head out of your ass for once in your life. I did not say that it was impossible for government health care to provide a sufficient level of care without shortages. I said it was impossible for Obama's plan to do so, because the supply of medical care is highly inelastic.

The socialized health care systems of Europe are generations old. The health care markets in those countries have had sufficient time for new doctors to be trained, new hospitals built, etc -- i.e., for supply to rise to meet demand.

What Obama is proposing to do is take a health care market that is currently straining to support 270,000,000 and add another 45,000,000 new consumers to it. That's a 15% increase. Obama is proposing to accomplish this not gradually over the course of several generations, but right now, this year.

So to avoid shortages, we would need to increase the supply of health care in this country by 250000 doctors, 360000 nurses, and 150000 hospital beds, right now. The problem would actually be much worse, of course, since by cutting payments to doctors and hospitals ObamaCare would drive some of the existing players OUT of the market. But even if every doctor in America kept working, we'd still have to magically increase the supply by a quarter of a million, overnight. That's impossible.

Is it possible that, in the long run, the US healthcare market might stabilize and allow everyone access to health care? Sure, it is possible. We can do it one of two ways:

(1): Spend a lot MORE, and poach health care providers from other countries.(2): Endure a couple of generations of health care shortages while the market adjusts.

Ok - now, to repeat my basic point - from my perspective (represenitng several insurance carriers), not only is the insurance industry in most states not currently response to market pressures, but they actively lobby to be sure they won't be.

Of course businesses lobby to get the government to protect them from market pressures. That's nothing new. What I don't get is why the fact that the government currently shields insurance companies from many market pressures is an argument for *increasing* government restrictions on the freedom of the health care market.

Meth, my bad, dude. You are "a premium subscriber." That changes everything. Ha, is that like a first class airline ticket? Not sure who your company is, but I am laughing at you (and so, btw, is your insurance company).

But, hey, if you are happy with your arrangement, it follows that there cannot possibly be any reason for systemic reform. All that "commonweal" talk of our framers is so old-fashioned.

You've just made a quantity over quality argument. First of all, asia is 1/4th the world population and it only stands to reason that they will need so many medical practitioners to service an even larger populace.

Methadras, I ask you to reevaluate what you think "per capita" means.

"No, it doesn't. If you look at the facts of national healthcare systems, Europe and Asia create more doctors, nurses and hospital beds available per capita than your "Freedom - for Freedom Lovers!!" US healthcare system."

Methadras - They may also pay 50% to 80% less because frankly their economic setup heavily subsidizes that cost via the level of taxation they have to endure. Europe just as well.

No, if you look at all costs, the two nations with the highest life expectancy, Japan and Switzerland, spend 9 and 11.7% of their GNP on healthcare - vs. the USA's 18.4%. With more doctors, nurses, hospital beds per 1000 people.

Methadras - They are working on a precarious and unsustainable system.

No, the German system has been around for 110 years, the Japanese one about 80. The average age of universal healthcare systems are about 40 years globally, longer if you add the Communist systems which sucked at making shoes, but worked brilliantly in areas like creating literacy and making doctors and scientists.

Methadras - Quantity over quality. Guess which Americans will pick every time?

If they assume other peoples money will pay for it, Americans will demand both quanity and quality. But the reality is we either get as efficient as the Europeans and Asians and still deliver a good product --or we tax and ration in some combination even more than efficient, great universal healthcare plans in Europe and Asia now do.The days of sweeping all the cost into unfunded obligations and long-term debt floated by China are coming to a close.No more Bush full price prescription drug subsidy programs accompanied by tax cuts and T-Bills handed to China..

==================Dogwood - And yet they have egregious waiting lists for some of the most basic health care procedures, from stress tests to MRIs to joint replacement surgeries.

There is absolutely no public favor in any European, Asian nation, plus places like Israel, Australia, Canada to scrap universal care and get the Rightwingers "Best in the World!!" US style healthcare system brought in and inflicted on their citizenry.

@Rev. - good question. My point is not necessarily an argument for more governmental intervention into healthcare. But I stress the point that the insurance market operates at levels that we traditionally define as monopoly rather than free market because several posters here have expressed a lemming-like faith in the market - assuming 1) that insurance companies are sensitive to market pressures and 2) that such sensitiveness is efficient and preferable to any other possible system.

I am not blindly embracing the bills that are currently being worked out, but I don't fear reform. The high costs I currently subsidize for the uninsured and under-insured trouble me, and I am eager for a solution.

Marcia - my firm represents a number of insurers throughout 4 states in the southeast. Some of our clients are HMO's. Almost all of our clients who offer med mal insurance are solely excess insurers (both regionally and natioanlly). We represent a range of other insurers as well. Much of my work involves equitable subrogation claims and bad faith failure to settle claims.

End of life during terminal illness which is now a doctor/patient/family decision, will become after the collective budget crisis needs of a socialist country gets its nose under the tent, no exit for those with critical care medical needs after the rules are applied from the State Life Panels (which sound so very much more reasonable than Death Panels). The Life Panels will decide how much life you are entitled to expect at your age and ability levels, unless of course you are a State Apparatchik.

There is absolutely no public favor in any European, Asian nation, plus places like Israel, Australia, Canada to scrap universal care and get the Rightwingers "Best in the World!!" US style healthcare system brought in and inflicted on their citizenry.

Strawman. I didn't claim there was such a desire.

I merely pointed out that having more doctors and hospital beds does not mean their system is necessarily better.

They have more doctors and beds but they have to wait significantly longer than Americans do for routine procedures.

And if they get tired of waiting, especially Canadians, then they cross the border and get care in the U.S.

So, in essence, they have more, but not enough, so they outsource their health care to other countries.

Why? Because if something is "free" then there will be shortages. National health care is nothing more than government price control, and government price controls always lead to shortages.

Revenent - The socialized health care systems of Europe are generations old. The health care markets in those countries have had sufficient time for new doctors to be trained, new hospitals built, etc -- i.e., for supply to rise to meet demand.

What Obama is proposing to do is take a health care market that is currently straining to support 270,000,000 and add another 45,000,000 new consumers to it. That's a 15% increase. Obama is proposing to accomplish this not gradually over the course of several generations, but right now, this year.

You badly underestimate what America can do under urgency, with a centrally directed plan. After Sputnik, a combination of Gov't and industry collaboration plus scholarships for scientists and engineers doubled the supply in 6 years.

America doubled its prison capacity in 10 years.

The US military can train a medic to do about 70 of the most common medical treatments, plus extensive 1st aid, in 18 months. Universities can create an RN from a BS in two years, and a BA in 2 1/2. A nurse practitioner from a suitable nurse or EMT in about 2 1/2 years.

In other nations, they test and put what they think are suitable candidates for medical careers in the pipeline as HS sophomores taking "AP" premed courses, and med school starts on HS graduation for the especially gifted or after 1-2 years of college. There is no AMA cabal restricting # of med school spots, and students have low costs..Rather than be like the "Best in the World Freedom-Lovers!" system of the USA where we must import 30% of the doctors we need - universal healthcare companies generally produce a surplus - which if there are too few medical practice jobs, fit in very well in drug R&D, biotech, teaching more prospective nurses, doctors, techs..

A living well is necessity, if not to keep the family at bay. As for me, I have willed that there will not be any extraordinary means to keep me alive... no machines or tubes. If I cannot eat then I will starve. All I ask is that I'm stoned on morphine to alleviate the pain. I will waste away and die. It is the least I can do for my loved ones. They all know what I think of this life and the next so I expect them to follow my wishes.

If they don't, I will not know in that I am stoned on morphine. Unfortunately. I have experienced a morphine drip and it sure beats vicodin.

My MIL had a severe illness a few years ago. She required a feeding tube for about three weeks. Once she had recovered sufficiently, she began eating in the usual way and the tube was removed. She had several more good years after that.

I get the impression that some people think that feeding tubes (1) are always permanent, (2) only prolong suffering and postpone the inevitable, and (3) are a form of torture invented by evil doctors in order to justify getting more money.

The US military can train a medic to do about 70 of the most common medical treatments, plus extensive 1st aid, in 18 months. Universities can create an RN from a BS in two years, and a BA in 2 1/2. A nurse practitioner from a suitable nurse or EMT in about 2 1/2 years.

We've had a serious nationwide nursing shortage for years and the problem will get bigger with the aging boomers.

So, given the current shortage, where are we going to find all of these new nurses?

Pay and benefits will have to be increased substantially, but since HR 3200 is all about cost control, I don't see that happening.

My MIL had a severe illness a few years ago. She required a feeding tube for about three weeks. Once she had recovered sufficiently, she began eating in the usual way and the tube was removed. She had several more good years after that.

A couple weeks ago, a member of our church became gravely ill and was put on life support.

She was non-responsive, her doctor wasn't hopeful, so family members began to discuss turning off the ventilator.

Five days later, she walked out of the hospital. On day six, she returned to church.

As others have stated, you don't know if you are spending 80% of the money on the final days of your life until you are actually dead.

Some cases are more clear cut than others, but there are way too many stories like this one to allow me to be comfortable leaving these decisions in the hands of government.

Dogwood already adressed this, but let me pile on -- where are all the doctors and nurses going to come from if payments to providers are going to be cut? We're in a shortage already, which is an indication that the market is already broken due to government meddling -- if the remuneration were high enough, there would be enough doctors and nurses to fill the "necessary" spots. But Obama et al. are talking about cutting payments to providers, which will further shrink the supply. Why should any smart person choose to go into medicine where they'll be overworked and underpaid their entire career? Altruism will only you get so many candidates. It doesn't matter how quickly new doctors could be churned out of a revamped system -- no one is talking about revamping the med school system now anyway, and applications will be dropping faster than Obama's favorability rating.

Some type of Medicare rationing is already going on. Last year, my boss's mother's heart started giving out. After about 2 weeks in the hospital, he said Medicare insisted on moving her to a skilled nursing home, where she stayed another 2 weeks before moving to the hospice and dying the next day (my birthday).

My second cousin kept putting off valve replacement surgery and keeled over one day. His son (alone) insisted on keeping him on life support for 3 weeks before they finally pulled the plug. He was an insurance salesman, but he was on his wife's insurance, which must have paid a fortune.

My grandmother almost died, thanks to British doctors refusing to listen to her, and insisting that she take an aspirin and get on the plane back to the U.S. When she got back here, exploratory surgery to find the intestinal hernia which was causing her excruciating pain led to a severe infection.

She smoked for 40 years of her life, but had quit about 20 years before this particular illness. She had circulation problems and was in her 80s. Eventually, her leg had to be amputated from gangrene. She was in a drug-induced coma for the better part of a month.

So yeah, a lot of money was spent on her care. And she died about 3 years later.

But you know what? Those 3 years were great years for her. After her leg was removed, she perked right back up, and her general health became much better. With help from rehab, she learned to get around quite well in a wheel chair. Thanks to a lifetime of hard work and wise investments, she was able to hire someone to help her with cooking and driving and the like.

If the government and the doctors were primarily concerned about costs, and the relative merit of spending health care dollars on her than on somebody younger with more "quality life-years" ahead of them, would she have gotten those extra 3 years? I don't want to find out.

Some type of Medicare rationing is already going on. Last year, my boss's mother's heart started giving out. After about 2 weeks in the hospital, he said Medicare insisted on moving her to a skilled nursing home, where she stayed another 2 weeks before moving to the hospice and dying the next day (my birthday).

Was this rationing or was she dying of congestive heart failure and there was no cure and no way to extend her life?

In other words, the hospital could do absolutely nothing for her, therefore, Medicare didn't want to pay for the hospital stay.

Would be interested in hearing more details about that situation if you have them.

My only experience with Medicare was my dad's emergency quadruple bypass a couple years ago at age 70. He hasn't slowed down since.

Not really. The insurance companies offer you the "option" to buy contracts with them that give you different levels of coverage. It is your choice to choose a full bells and whistles coverage or go for a bare bones catastrophic coverage plan.

Your choice.

When you buy the contract you know what will and won't be covered and under what circumstances. The contract with the insurance company is that they pay for services, without rationing or limitations OTHER than what you agreed to in your contract.

When the government owns your medical care there is no contract, no guarantee, and who are you going to call when they tell you that there are no services for your particular problem. No one. You can't sue the government.

Contrary to the lies that Obama is perpetrating, insurance companies can't drop you from coverage because you are sick. Don't pay your premiums?....you bet. But if you continue to adhere to the contract and as long as you didn't lie to get the contract....the law (isn't this a law blog?) is on your side and the insurance companies have to pay.

The difference between a contract between two parties, you and the insurance company, is miles apart from the Government dictating to you what the rules are. One is two parties in mutual agreement.....the other is totalitarian/socialists in control of your life.

You pick. I trust the insurance companies more than the government. The insurance companies need US to contract with them to stay in business.....the government can just force us to contract with IT.

Tom Ridge, the man handpicked by President Bush to be the first Secretary of Homeland Security, admits that he raised the terror alert level in the weeks leading up to the 2004 election due purely to political considerations and pressure from the Bush re-election campaign, despite having no intelligence suggesting that an attack was any more likely than it had been before.

Gee, doesn't that make those who supported Bush because of 'national security considerations' look like a bunch of monkeys-- they manipulated you like a marionette and you let them.

Eli -- Your post has too many errors to count. It is a gross misrepresentation of Ridge's claims (which are not even the shocking revelation that CNN makes them out to be, much less the bombshell that Eli has invented).

wv "under" -- where Tom Ridge was relative to the pressure from Ashcroft and Rumsfeld in the days before the 2004 election. But luckily, the brave Homeland Security secretary held his own (with the support of others at the meeting he was discussing), and the threat level was NOT raised.

Contrary to the lies that Obama is perpetrating, insurance companies can't drop you from coverage because you are sick.

This is true. My husband and I have insurance through an individual policy and I got cancer. BCBS has been stellar about paying, even when I flew to TX and was treated at M. D. Anderson (top notch, I recommend it highly.) Our premiums have ratcheted up rather steeply over the years, but we're keeping the individual policy because we know they can't kick us off it.

Long time lurker, first time commenter. As a Canadian, I find this health care debate fascinating. The people up here who are following this are baffled that our southern neighbors are considering moving in our direction.

One of Dust Bunny Queen's remarks above really resonated with me.

"When the government owns your medical care there is no contract, no guarantee, and who are you going to call when they tell you that there are no services for your particular problem. No one. You can't sue the government." This is exactly correct, and reality for people living under government health care plans.

Government health care changes the relationship between the citizen and government, permanently. I live in Alberta, the most conservative province in Canada, and even in this right wing bastion(lol) any discussion about coverage that does not involve buying additional bulldozers to push more cash into the pit (Health care constitutes almost 40% of the provincial budget) causes near riots. Ideas such as private clinics for joint replacements and angioplasty to relieve the years-long waiting lists for people willing to pay, for example, causes outraged objection to impending "American-style healtcare" (a grave accusation that generally stops the debate cold) or "Two tiered health care". Market-oriented reforms are generally non-starters. Still, the Alberta government keeps trying to implement variations that follow the letter of the federal law while providing a bit of choice and competition, but it's a constant fight.

The greatest horror to many Canadians is the thought that some "rich" person could, somehow, somewhere, jump ahead in line by deploying his own resources, thus depriving a "poor" person of that treatment, which they are owed by virtue of being in line for it. People simply do not have options. That's why people sometimes go to the States when they can afford it.

Canadians who are generally healthy, or have sporadic contact with the medical system are content with the services provided. They imagine that most medical expenses are covered by the government, and don't think too hard about it unless they themselves end up with a chronic or acute illness. And that is when they realize that, unless they are covered by supplemental healthcare via Blue Cross or their employer's plan, that the public plan is pretty craptacular.

While brevity has never been my strong suit, I want to share one story. Perhaps this is the same in the US, I don't know. Eight years ago, my husband's 23-year-old first wife became suddenly ill, and went into a coma. My husband was told a few days later that she would not recover, and he was pressured to withdraw food and water. He tries not to dwell on it too much, because he still doesn't know if it was the right thing to do. He was completely devastated, and followed the doctor's advice, which was delivered in no more than 15 minutes (total face time with this doctor: less than an hour). The young woman took weeks to die (she was perfectly healthy otherwise). There was no way to get a second opinion, no way to find out if the random doctor to whom she was assigned was any good (not that it would matter)- no way to get additional information (except from my husband's cousins, who are both doctors in unrelated fields- they read the chart for him). People have heard this story and exclaimed, "this is why you should have a living will!" but how many 23 year olds out there have them?

Regarding "death panels": as Colby Cosh pointed out regarding Alberta's Out Of Country Health Services Committe http://www.health.alberta.ca/documents/OOCHSC-Info-Sheet.pdf "Canada doesn't have 2 healthcare systems. That panel's whole job is to deny treatments the monopoly does not happen to offer."

Of course, to be fair to the Canadian system while I share anecdotes, my 75-year-old grandmother was diagnosed with breast cancer last year, and she had her surgery within 6 weeks of the doctor finding the suspicious lump. So, some parts of the government plan work all right.

After Sputnik, a combination of Gov't and industry collaboration plus scholarships for scientists and engineers doubled the supply in 6 years.

There are two glaringly obvious problems with that example.

The first is that the country responded to Sputnik by sharply *increasing* the percentage of GDP going into science and engineering. Obama, the Democrats, and you all want to reduce the amount this country spends for medical care. If Congress had responded to Sputnik by saying "we must stop these greedy scientists from profiting at our expense", it might make a good example for your case.

The second obvious thing you're missing is that it still took years to produce the surge in scientists and engineers. The mostly wonderfully centrally-planned national socialist government of your dreams still can't train an engineer -- or a doctor -- without taking years to do so.

And that's the point I've already made. Yes, the government can increase the supply of doctors by throwing a lot of money at the problem, but it still takes time. Obama and you are planning to dramatically increase demand NOW when the supply will take years to rise to match. That means shortages, period, end of story.

The US military can train a medic to do about 70 of the most common medical treatments, plus extensive 1st aid, in 18 months.

So if we passed a health care plan that provided nothing more than those 70 basic medical treatments to the people who currently lack medical care, we would only have to endure a crippling shortage of basic health services for the next year and a half. Goody gumdrops.

But of course, nobody's proposing restricting the uninsured to just basic care. So it wouldn't accomplish much of anything. We'd still have a sharp increase in covered surgical procedures with no increase in surgeons; we'd still have a sharp increase in cancer treatments without any increase in people who can provide them. Etc, etc.

And that 18 months is the shortest time. For nurses, it is (as you noted) a minimum of two years, and that's assuming you can find a a few hundred thousand people eager to enter an industry in which the government is slashing budgets and increasing regulatory meddling. For doctors, it remains a decade or more. There's no magic bullet to produce those 250,000 doctors overnight, or even in a few years.

where we must import 30% of the doctors we need

We don't "import" doctors. Doctors and medical students come here because we have the best medical schools and the best working environment. It is a BAD sign when the only doctors willing to work in your industry are the ones born in your country.

In the universe of employer-based health-care, there's not only never been an instance of changed-out plans, or changes in existing plans, in the history of such, just as in individually purchased plans, there's never been any changes upon anniversary/renewal dates, in the history of such.

Uh . . . even if you are one day unable to pay the premiums? If so, that's a great program. Everyone should enroll in it immediately.

Tell us more about the magical health plan you have in mind in which the average amount paid into the plan by citizens is somehow *less* than the amount of coverage provided by the plan. You'll be a shoo-in for the Nobel Prize in Economics. :)

@Rev- I wasn't suggesting a magical plan, or even universal coverage (though many developed nations have managed to do it fairly well).

I was simply pointing out that the crux of Joan's (and others) puzzling defense of the EXISTING system seems to be a claim (Joan's was explicit) that under no conditions will she ever be denied coverage by her existing private plan.

For the most part, everyone in our country gets health care (at least for catastrophic illness or injury). What a large (and apparently growing) number in our country do not get is cost coverage for that healthcare. Those costs (which are very high, in part because there is no real market incentive to cap them) are distributed across those of us who 1) have coverage and/or 2) pay taxes. This is a structural difficulty.

I am interested in reform that addresses the current structural difficulties - since I think they are serious and harmful to the longterm well-being of this country.

A miracle has occurred. Suddenly, 75% of those people currently without health-care/health-insurance plans suddenly, *independently, personally*, find and/or choose to lay out the bucks to buy into some sort of health-care/health-insurance policy, similar to what most have, within the next week, or even the next year or three. Would that change the framing of the issue of medical-professionals shortages?

Yes, I've noticed you aren't suggesting anything at all. You're attacking the idea of private insurance, but not actually suggesting any alternative. Curious.

I was simply pointing out that the crux of Joan's (and others) puzzling defense of the EXISTING system seems to be a claim (Joan's was explicit) that under no conditions will she ever be denied coverage by her existing private plan.

It is "puzzling" in the sense that if I said "aspirin always cures my headaches", it would be "puzzling" that I didn't account for the possibility of not being able to afford aspirin. Which is to say, not puzzling at all.

What a large (and apparently growing) number in our country do not get is cost coverage for that healthcare.

Weasel words. How many is "large"? What percentage is the "growing number", and how fast is it growing? Also, explain why it is my problem that you have to pay for your own medical care with your own money, as opposed to paying for it with my money.

Those costs (which are very high, in part because there is no real market incentive to cap them)

The incentive to cap them is the same as the incentive to cap any cost -- people's willingness to pay. This incentive works in every industry, medicine included. Prices are rising because (a) people can afford them and (b) supply is not growing fast enough to match demand. One more reason why artificially increasing the demand by subsidizing medical bills is an idiotic idea.

Suddenly, 75% of those people currently without health-care/health-insurance plans suddenly [...] lay out the bucks to buy into some sort of health-care/health-insurance policy [...] Would that change the framing of the issue of medical-professionals shortages?

The law of supply and demand will not magically be repealed just because 32 million Americans suddenly came into a lot of money, no. Either prices will rise and prompt people to purchase less medical care until (decades later) supply catches up with demand, or prices will be artificially held in check by government fiat and we'll have regular shortages.

The question Americans need to ask themselves is simply this: "are you willing to make do with less medical care than you currently use, for at least the next ten years, so that the less fortunate can have more than they currently use?".

One last try to respond to you briefly before I move on to much more fruitful and rewarding endeavors. A Terry Pratchett novel, perhaps.

What I am somewhat surprised by (though I am not sure why, having been a sometimes reader of regular commenters here) is your seeming lack of awareness that you (and I) are ALREADY paying for the costs of healthcare given to the uninsured who receive medical care for which they cannot afford to pay.

Wouldn't it make some sense to consider structural reforms which rationalize, render more transparent, and potentially reduce those costs we ALREADY ABSORB by including the uninsured within a managed risk pool?

The question Americans need to ask themselves is simply this: "are you willing to make do with less medical care than you currently use, for at least the next ten years, so that the less fortunate can have more than they currently use?".

Rev, here's the point you're skipping over with regard to proposition: If that 75% suddenly did just that, paid for and/or obtained the coverage ALREADY available (which thing, by the way, is what many conservative/independent/libertarian people are advocating they do), what you're talking about wouldn't be ABOUT what anyone's *willing* to do less with or give up. They'd be part of the "US" you're assuming in your question.

And the situation, w/r/t shortages of medical personnel, would be what it is. So I ask again, under THAT scenario: "Would that change the framing of the issue of medical-professionals shortages?"

I mean, it's one thing to dispute that 47 million figure for the uninsured as an argument for wholesale nationalizing the system (I do). Hell, it's one thing to dispute that 47 million figure as even remotely accurately representing the concept, much less reality, of people not having access to health-care coverage/insurance (I do).

It's another thing to imply that the accessibility and affordability of health care depends on those 47 million *NOT participating* in our current system--**including even those 37-million-ish who could right now be participants in the current system just as it is**--and, sweet Lord--**even including those many millions who could, and can, afford for-pay premiums** but choose not to.

you (and I) are ALREADY paying for the costs of healthcare given to the uninsured who receive medical care for which they cannot afford to pay.

I'm not. My doctor won't even see you if you can't provide proof of insurance. But you're right that, if I had to make use of another doctor or visit a hospital, part of my bill would be expenses from treating uninsured patients, which the hospital passes on to me.

There's exactly one way to prevent that from happening: forbid hospitals from treating people who can't pay. Perhaps that's what you're proposing. If not, that means that the costs of treating those who cannot pay will wind up passed on to those who can.

Under the current system, people without insurance are forced to pay what they can before the remaining expenses are passed on to others. If they are given public coverage (paid for by me), less of the bill will come out of their pocket (and more will come out of mine). Plus, of course, since their personal costs are lowered, they'll consume more medical care (and pass more bills on to me).

So no, I'm not "unaware" that I currently end up paying for those who can't pay. It is just that I'm much more intelligent than you, and thus realize that my current obligation to pay for the care of others is about as low as it can get without kicking sick poor people out of hospitals altogether. :)

If that 75% suddenly did just that, paid for and/or obtained the coverage ALREADY available (which thing, by the way, is what many conservative/independent/libertarian people are advocating they do), what you're talking about wouldn't be ABOUT what anyone's *willing* to do less with or give up. They'd be part of the "US" you're assuming in your question.

If 32 million people were granted the coverage currently available, either 32 million of those who currently have that coverage would lose it or a large number would lose a proportionate share of their coverage. That's what always happens when you suddenly add a large number of consumers to a slow-growing market.

So I ask again, under THAT scenario: "Would that change the framing of the issue of medical-professionals shortages?"

No. Why would it? The problem would remain exactly what it is: there isn't enough medical care available to give everyone as much as they want. That's why prices are rising now, and why they'd rise even more egregiously if you suddenly threw an extra 32 million people into the pool.

Today, my grandmother is getting surgery on her hip, which she broke yesterday morning. I don't have any energy for this health care debate, but I keep thinking of Obama saying his grandmother should have just gotten a pill for the pain. I can't believe he says the things he does, sometimes. Damn.

Stupid enough to believe the religious rhetoric replacing God with the state, and stupid enough to believe that the rationing required to meet the influx of 47 million people into the medical system won't mean the elderly get stiffed ...in order that they become stiffs.

In my quip, I gave no approval of Obama's invocation of religion. I disapproved when Bush did it, I disapprove now (though I think Hoos is correct that Bush actually believed, e.g., that his understanding of the scripture mandated aspects of his foreign policy)

Nor, Pogo, have I called for single-payer, though I have been critical of the insurance industry and I do support some aspects of health care reform.

But Pogo and Hoos, you are both correct in one thing. No thinking person could possibly examine the moral precepts of Christianity or the Gospels and find any iota of support for making medical care available to the poor or downtrodden. Who could ever suggest such a thing? Obama's cynicism clearly knows no bounds.

"the moral precepts of Christianity or the Gospels and find any iota of support for making medical care available to the poor or downtrodden..."

More slipperiness. Name one person here that has claimed such a thing. What is clearly not in the Gospels is a Christian basis for demanding tax support and a government model for providing health care.

If I missed it, say in John or one of Paul's letters perhaps, please cite them.

I’ve said be before, I would be less opposed to a single payer system if there were some assurances that those who are beneficiaries of the system actually had a financial stake in it. For starters, I don’t believe that an illegal alien population estimated to be around the size of Holland should be able to utilize our health care system. Period. If Manuel is sick, Manuel can go to his home country for care. Otherwise he can fill out the appropriate paperwork to become a US citizen.

Second, I could care less you only make $20k per year, if you’re going to benefit from a universal health care system then by Allah you should have to contribute to it. There are far too many people living off the nation than actually contributing to it and that has to stop right now.

Third, there is a finite amount of money, doctors, nurses and hospital beds and I do think there has to be a certain amount of rationing. Sorry but if you have liver cancer as a result of knocking out a bottle of gin every other day for the last 20 years then you get to the back of the line. Sorry but a good chunk of the chronic illnesses out there are the result of piss poor lifestyle choices. That sound cruel? Fine, picture your dad or mom needs a liver transplant because of a congenital defect but is third in line because Jerry Garcia and Lindsey Lohan were next in line. Perhaps a prioritization system that encourages a healthier lifestyle would go farther than you think.

Finally there has to be a paradigm shift in terms of our expectations of health care. A heavier reliance on the individual to be responsible for routine care whereas catastrophic care is left to the insurance or single payer. All I am seeing now with Obamacare proponents is we can all get to ride the pony and we’ll worry how to pay for it later.

many on the religious right loved the eschatological dog whistles Bush sounded in the run up to invading Iraq or in relation to Isreal,

yet when a democrat president, while speaking to religious leaders, suggests that a policy aimed, in part, at providing medical poor to the poor and infirm is consistent with the Christian faith, the religious right howls with outrage.

But Pogo and Hoos, you are both correct in one thing. No thinking person could possibly examine the moral precepts of Christianity or the Gospels and find any iota of support for making medical care available to the poor or downtrodden. Who could ever suggest such a thing? Obama's cynicism clearly knows no bounds.

I don't recall saying any such thing. I simply think Obama paraphrasing scripture to make a political point is complete horseshit. He's never given me one single impression he gives a shit about Christianity or religion in general. His piss poor excuse of a church was nothing more than a forum to rant against whitey rather than a house of worship.

And who said the 47 million uninusred are all 'poor and downtrodden'? Last time I checked if you're poor, you can get Medicaid. Then there's the SCHIP program. Then there's 10-15 million illegals in that 47 million which need to GTFO of my country as I don't owe them jack. Then there's a percentage of that 47 million who simply choose to spend money on things other than health insurance.

Now when you can provide me a reasonably accurate figure of American citizens truly uninsured who cannot afford health insurance or are uninsurable because of chronic illnesses then let's talk about fixing that problem.

Again, name the Chrsitian principle espousing the provision of charity by government.

Show me the Christian principle that provides an exception when people are working for government. Is there some parable about a tax collector who accepts Christ but gets to be a dick when he is on the job?

"Show me the Christian principle that provides an exception when people are working for government."

You misunderstand, or are intentionally misdirecting.

Christ was admonishing the lowest of the low, the government tax collector, to give back his dishonest takings, and be from then on an honest person.

It says nothing about Jesus having a preference for the government as the best vehicle for providing charity for the poor, so I have no idea how you stretch that passage into a demand by Jesus for an egalitarian health care system.

Show me the Christian principle that provides an exception when people are working for government

Back up folks. The government doesn't create money, the citizens do. That is, charity by the government is charity by the taxpayer, albeity forced charity since my choice is pay taxes or go to prison.

The problem with Obambi citing scripture to tug our Christian hearts is that I simply don't trust the government to 1) use the money efficiently and 2) use the money for its allotted purpose ie: health care.

Anyone who is remotely observant would see that the government already looted the SS fund and replaced the money in there with IOUs. The so called stimulus bill turned out to stimulate a whole bunch of Obamabi's constituency but hasn't done a whole lot else.

I remain astounded by the blind faith that people still put in a governemnt that has led us down the path of putting us in a situation where we will never be able to get out of debt short of a complete economic collapse and yet demand more government programs.

And, the type of sarcasm you are showing is precisely why religious language works sometimes and doesn't work other times. You clearly have a disdain, but at the same time you're willing for that disdain to be used to manipulate people who you feel were manipulated before.

Only people recognize cynicism, and disdain, and often when they are being used.

That you are making a contrast only between religious language used for the Iraq/Afghanistan wars and religious language used in regards to the present health care debate, then making it seem like blatant hypocrisy on the part of the right is disingenuous. Bush did a lot more than invade Iraq, and his reasons for even that were not about building an empire over an infidel people. Rather, he had in mind justice--to help those being oppressed. Whether the military is the best tool for that is a good question to be debated.

If the Good Samaritan had seen the man getting beat up, would he have been justified in stepping into the fight and stopping the beating before the man had to go to the hospital?

But, it's not just about the war. Bush used his idea of compassionate convervatism to expand government well beyond what a lot of folks liked, and expand it not to shoot people but to help them. To help people around the world who have AIDS, who are hungry, who need to read or write or find other help.

So, get off your high moral "Jesus is just like me" soapbox and realize that if you're not really sincere about religion it comes off really ineffective to lecture people about the religion they have.

Jesus, no doubt, is not entirely happy with a whole lot that goes on in this country. But as it's been said a few times on this thread, Jesus wasn't talking about other people helping other people. He was talking about you. He was talking about me. Jesus didn't say a lot about the Roman empire, but he did say there's no religious excuse for not helping those who are in your immediate circle. Help your neighbor is not figurative. Help your brother is not figurative. Help those who are close to you.

There's also a pretty strong sentiment about proving through actions, and I bet a whole, whole lot more people would be open to the Obama health care plans if he were to do a massive overhaul and weed out corruption from the system in a fair, non-partisan way. But he won't. Because he doesn't really believe what he says and the stated goals aren't really what he is ultimately after.

Jesus did say a fair amount about using religion for personal gain and power. The reason why he had a few sharp things to say to Pharisees and Sadducees.

The issue is: How can you ever really know you're treating someone who is "in the last 2 years of life" ... you don't, until they're already dead.

So the argument about how much we spend (and the implication is, waste) on people in their final days is meaningless. We treat everyone in the hope that they'll survive for a long time. *Unless* that individual chooses to forgo care. Because we all know that many, many people have received a horrible prognosis and go on to beat cancer, or whatever illness they have that was supposed to kill them.

Furthermore, when the NYT conflates a government drone with a doctor, it's just rank dishonesty. Nowadays, when I read something from the NYT I hear it in the voice of "Pinch" on Red Eye, so it's hard to take seriously anyway.

This here is the key, but so many are now used to "someone else" paying all or most of their medical costs from dollar one, I doubt we can ever get back to that.

Actually I think we will and that will be the point where premiums for insurance covergae that pays for everything will simply become untenable. At that point the market will respond and employer groups will simply resort to providing cat care coverage and we'll have to get used to it.

Again this doesn't mean that it won't happen with a public option either. The idea that the public option will be able to cover everything from annual doc visits to heart transplants and drug rehab is a pipe dream. We are already fast approaching the point where there isn't enough taxable income to even pay off the debt we have now let alone pay for everyone's medical care. I simply cannot understand why few people understand this.

Yours was a very thoughtful post, and I appreciate it. Between you and me, I actually did catch that key point in the Gospels you referred to. I just don't hold it as a creed.

I am guessing from the tone of your post (and from your name tag) that you are Catholic. If so, I add that while I myself am not a Catholic, I have a lot of respect for the history and traditions of Catholic church. I was raised in a very strict, Protestant fundamentlist church and school, and even have four year degree from a prominent fundamentalist college and I have long admired the tendency towards scholarly thoughtfulness (as opposed to anti-intellectualism of my own tradition) of the Catholic church, at least historically.

My brief confessional about my fundamentalist Christian upbringing surely explains the disdain I have for Christian fundamentalism now that I am an adult, and surely explains the base delight I take in noting the hypocrisy of the politically active wing of American Protestant fundamentalists.

Something odd about this blog, or the blogosphere generally perhaps, has me in a position of defending health insurance reforms that I am ambivalent about, but the turn toward the connection between religion (or maybe just religiosity) and health care helpfully peeled back some of the ideological (not theological) undercurrents of this debate. And at the same time presented me with temptations I could not resist - namely, at least on one narrow issue, hoisting the religious right on its own petard.

But again, I appreciate your post, even though I do not agree with all that you said.

My brief confessional about my fundamentalist Christian upbringing surely explains the disdain I have for Christian fundamentalism now that I am an adult, and surely explains the base delight I take in noting the hypocrisy of the politically active wing of American Protestant fundamentalists.

Why is it hypocrisy? It's only hypocrisy if the religious right believed that Obama was truly a man of faith and took umbrage at his words simply because he's a Democrat. In other words, if Obama actually had displayed an image of a man of faith he probably would have gotten away with it. But someone who exhibits disdain with his bitter clinger comment, it certainly looks more like hypocrisy on his part than anyone on the right. After all, it seems like he's willing to cling to his bible when it serves his purpose.

Wouldn't it make some sense to consider structural reforms which rationalize, render more transparent, and potentially reduce those costs we ALREADY ABSORB by including the uninsured within a managed risk pool?

It would make some sense if those particular uninsured were actually insurable.

Here is how insurance works. If you want to insure against a probable event or risk (getting sick) you make a contract with the insurance company who takes your premiums and in return if the risk occurs, they pay the agreed upon amounts.

If you are already sick or have pre existing conditions, like Joan or like my husband, there no longer is any "risk" that you might get sick....the event has already happened and the insurance company would be fools to make a contract with you. Same thing if you were trying to buy fire insurance WHILE your house was on fire.

Joans and everyone else's premiums will go up periodically, with age bands. It has nothing to do with illness. As long as she pays her premiums, her contract is in effect. They can't raise your premiums in mid contract just because you got sick, unlike auto/home insurance which CAN if you have claims. These things are all controlled at the STATE level and vary from state to state.Everyone is confusing insurance with health care. If you want everyone to get health care, even those who are already ill, then address that issue instead. But don't completely destroy the insurance industry, that serves a lot of people quite well, to accomplish that goal.

I agree that there should be some minimal amount of health care that everyone should be able to access. The question is how much care and who is going to pay for it......and who is going to decide who gets what care?

The other issue about insurance that should be addressed, reformed and doesn't need a zillion page bill that changes the entire country is portability.

If you are ill and have an existing insurance policy and you lose your coverage through no fault of your own, perhaps your employer dropped the coverage, possibly you changed jobs and there is no coverage from your new employer, you cannot get a "new" policy on your own because you have pre existing conditions. There should be a time frame to allow you to get coverage without consideration of the pre-existing condition. Similar to when seniors change Medi-gap policies where there is a sort of 'free window'. This would create portability.

Disclaimer: I'm also a licensed insurance agent and have been for over 25 years. I occasionally and rarely sell a health/medical/med sup policy if my clients ask me about it but it really isn't of much importance to my business. Life insurance is more cruicial to what I do as a part of financial planning. Actually portfolio managment and investments are the core of my business. So if I argue for the health insurance industry, there is no venial reason. I just think the options proposed by the socialists in charge are disasterous to the economy and to everyone on a personal level.

I know quite a few people that remain angry regarding their strict religious upbringing well into adulthood and sometimes for the rest of their lives.

It shapes their views as adults, using their former religion as a negative bellwether by which to reliably guide them in the opposite direction, and leads to taking perverse delight in the inevitable hypocrisy, sin, moral errors, and criminality among believers, where pity and reproach would be more appropriate.

Thanks for your kind words and sharing a bit of your background. Sometimes it's more easy to be combative in these sorts of places than collegial. Your tone and comments are welcomed, and refreshing for me (and a good example for me!).

I'm not Catholic, actually. About as Protestant as a person can get. Indeed, I bet you and I share a fairly close ecclesial background. Some folks see the hypocrisy and often blindness of conservative Christianity and ditch. Something kept me, and so I'm in that wing who thinks what went wrong can and should be made better. Not in giving up the good bits, but in embracing the good even more so as to increasingly wash away the bad.

The disdain is understandable, but do remember that just because the noisy ones tend to be the worst sorts of hypocrites there really are genuinely good, loving, sacrificial men and women who really do live, or try to live, the call of the NT. They might not always been in charge, but they're the heart and the hope--because they're the humble ones who get the point--the point of the real source of heart and hope.

I think in my staying within the movement, I've had to focus my eyes on those people, not on the bad side. In leaving, I suspect, you found it too difficult to see anything else. And I'm sad about that, because I understand and it makes me pretty angry that what was possible was undermined by men and women with ulterior motives in abusing, and ruining, their religion.

This did, by the way, make me equally mad at the religious right during the 90s. And makes me pretty much as anti-Huckabee as possible.

I am sure you do know them, just I know many who, whether raised in fundamentalism or late converts, cling to re-assuring religious and political dogmas in order to avoid the hard work of thinking or engaging with the world.

Real leadership, real help, would argue that the system is unwieldy, needs fixing, and then fight to bring reforms to what does work, broadening help to those who need it, while not breaking the system for whom it really does work.

In the absence of real leadership from the private health care industry, the government is filling the void. The prospect of Hillarycare, thirteen years ago, was private health care's wakeup call.

Instead of addressing the issue, they chose to ignore it. Private health care turned up their noise machine to drown out their wakeup call.

Now private health care, like a procrastinating high school student, is pleading for a second chance, that this time they will do something and it will meet our expectations.

But this is a hard world, with few second chances for slackers. They lack my sympathy.

But it is a simple, objective fact that the supply of available medical care is highly inelastic. It takes one to two decades to add a new doctor to the existing supply.

We can get them the same way we get high tech workers -- poach from India and China. Maybe they have to do two years' worth of residency in the US before we're comfortable cutting them loose. The immediate deficit will be in primary care physicians, not neurosurgeons. (Or if neurosurgery is an immediate demand, send the patients out of the country a la medical tourism.) Ship (more) nurses in from the Philippines.

"But it is a simple, objective fact that the supply of available medical care is highly inelastic. It takes one to two decades to add a new doctor to the existing supply".

We can get them the same way we get high tech workers -- poach from India and China.

Yes, FLS, I've already mentioned, multiple times, the possibility of poaching foreign doctors. But even assuming there are 250,000 English-fluent doctors willing to move to the United States -- how, exactly, do you plan to get them here without spending a LOT more money? Especially since their countries of origin aren't going to just shrug and say "oh, we'll just get by with less medical care". Those countries will either offer enticements for the doctors to stay, or (as is more likely in China's case) forbid them from leaving the country at all.

how, exactly, do you plan to get them here without spending a LOT more money?

It's been so long since I've been treated by a US-born doctor I can't really relate to your question. The standard of living is so much higher in the US that basically all you have to do is let them in.